Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis A Meta-Analysis

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
JACC. Cardiovascular Interventions (Impact Factor: 7.35). 11/2009; 2(11):1116-24. DOI: 10.1016/j.jcin.2009.07.015
Source: PubMed


We sought to conduct a meta-analysis to compare N-acetylcysteine (NAC) in combination with sodium bicarbonate (NaHCO(3)) for the prevention of contrast-induced acute kidney injury (AKI).
Contrast-induced AKI is a serious consequence of cardiac catheterizations and percutaneous coronary interventions (PCI). Despite recent supporting evidence for combination therapy, not enough has been done to prevent the occurrence of contrast-induced AKI prophylactically.
Published randomized controlled trial data were collected from OVID/PubMed, Web of Science, and conference abstracts. The outcome of interest was contrast-induced AKI, defined as a >or=25% or >or=0.5 mg/dl increase in serum creatinine from baseline. Secondary outcome was renal failure requiring dialysis.
Ten randomized controlled trials met our criteria. Combination treatment of NAC with intravenous NaHCO(3) reduced contrast-induced AKI by 35% (relative risk: 0.65; 95% confidence interval: 0.40 to 1.05). However, the combination of N-acetylcysteine plus NaHCO(3) did not significantly reduce renal failure requiring dialysis (relative risk: 0.47; 95% confidence interval: 0.16 to 1.41).
Combination prophylaxis with NAC and NaHCO(3) substantially reduced the occurrence of contrast-induced AKI overall but not dialysis-dependent renal failure. Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures.

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    • "Patients with previously known or suspected renal function impairment underwent a CT scan without contrast enhancement. Each patient received intravenous N-acetylcysteine and sodium bicarbonate to reduce contrast-induced nephropathy (8). "
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    • "The only preventive maneuvers generally accepted to have a limited but consistent efficacy are patient hydration with saline or bicarbonate solutions and the use of low-osmolality ICMs, which are supported by recent meta-analysis (Trivedi et al., 2010). Combination of NAC with intravenous bicarbonate reduced contrast-induced AKI by 35%, but not the number of cases requiring dialysis (Brown et al., 2009). Thus, at present, there are no highly effective methods to significantly reduce the incidence of CIN. "
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